A letter from Peter C Gøtzsche
... following his expulsion from the Cochrane Collaboration & the chaos within the group
The Cochrane Collaboration is a global independent network of researchers, health professionals, patients, carers, and other people interested in health. Cochrane contributors, from more than 130 countries, work together to produce reliable systematic reviews of the benefits and harms of healthcare interventions that are free from commercial sponsorship. These reviews are recognised as representing an international gold standard for high quality, trusted information. Many of our contributors are world leaders in their fields and our groups are situated in some of the world’s most respected academic and medical institutions.
Contributors are affiliated with the organisation through Cochrane groups, which are healthcare related review groups, thematic networks, groups concerned with the methodology of systematic reviews, and regional centres. There is no one place or office that is 'Cochrane'. Our contributors and groups are based all around the world. Each group is a 'mini-organization' in itself, with its own funding, website, and workload.
The Nordic Cochrane Centre
The Nordic Cochrane Centre was established in 1993, the same year as the Cochrane Collaboration. The centre has contributed substantially to Cochrane, particularly within research and IT development. We also co-author guidelines on standards for good reporting of research: CONSORT for transparent reporting of trials, STROBE for observational studies, PRISMA for systematic reviews and SPIRIT for trial protocols. These standards have been endorsed by many prominent scientific journals.
Cochrane reviews are being widely used in the area serviced by the Nordic Cochrane Centre and associated centres, with over 449,000 articles downloaded in 2016. This is an increase of 32% since 2015.
The Nordic Cochrane Centre has also worked closely with the Danish National Board of Health in producing evidence-based national clinical guidelines. The centre is primarily funded by the Danish Government, who also fund the national subscription to the Cochrane Library, ensuring free access for all people living in Denmark. If you would like to know more about our most downloaded reviews, please see our information about the Cochrane Library.
Director of The Nordic Cochrane Centre
Professor Peter C Gøtzsche graduated as a Master of Science in biology and chemistry in 1974 and as a physician 1984. He is a specialist in internal medicine; worked with clinical trials and regulatory affairs in the drug industry 1975-1983, and at hospitals in Copenhagen 1984-95. With about 80 others, he helped start The Cochrane Collaboration in 1993 with the founder, Sir Iain Chalmers, and established The Nordic Cochrane Centre the same year. He became a professor of Clinical Research Design and Analysis in 2010 at the University of Copenhagen. In 2017, he was elected to the Cochrane Governing Board, the Cochrane Collaboration's uppermost authority.
Peter has published more than 70 papers in "the big five" (BMJ, Lancet, JAMA, Ann Intern Med and N Engl J Med) and his scientific works have been cited 30,000 times (his H-index is 63 according to Web of Science). Peter is author of:
- Deadly psychiatry and organised denial (to appear in September 2015)
- Deadly medicines and organised crime: How big pharma has corrupted health care (2013)
- Mammography screening: truth, lies and controversy (2012)
- Rational diagnosis and treatment: evidence-based clinical decision-making (2007)
Peter has an interest in statistics and research methodology. He is a member of several groups publishing guidelines for good reporting of research and has co-authored CONSORT for randomised trials (www.consort-statement.org), STROBE for observational studies (www.strobe-statement.org) and SPIRIT for trial protocols (www.spirit-statement.org). Peter was one of the editors of the Cochrane Methodology Review Group 1997-2014.
His letter is below.
Trusted evidence. Informed decisions. Better health.
Nordic Cochrane Centre
Rigshospitalet, Dept. 7811
2100 Copenhagen Ø, Denmark
Tel: +45 35 45 71 12
A moral governance crisis: the growing lack of democratic collaboration and scientific pluralism in Cochrane
I regret to inform you that I have been expelled from membership in the Cochrane Collaboration by the favourable vote of 6 of the 13 members of the Governing Board. No clear reasoned justification has been given for my expulsion aside from accusing me of causing “disrepute” for the organization. This is the first time in 25 years that a member has been excluded from membership of Cochrane.
This unprecedented action taken by a minority of the Governing Board is disproportionate and damaging to Cochrane, as well as to public health interests. As a result of this decision, and a number of broader issues concerning the inadequate governance of Cochrane, in accordance with its principles and objectives, four other members of the Board have resigned.
As a result, the Cochrane Collaboration has entered an unchartered territory of crisis and lack of strategic direction. A recovery from this dire situation would call for the dissolution of the present board, new elections and a broad based participatory debate about the future strategy and governance of the organization.
In just 24 hours the Cochrane Governing Board of thirteen members has lost five of its members, four of which are centre directors and key members of the organization in different countries. Recently the central executive team of Cochrane has failed to activate adequate safeguards, not only technical ones (which are usually very good) to assure sufficient policies in the fields of epistemology, ethics and morality. Transparency, open debate, criticism and expanded participation are tools that guarantee the reduction of uncertainty of reviews and improve the public perception of the democratic scientific process. These are conditions and tools that cannot be eliminated, as has happened recently, without placing into serious doubt the rigorous scientific undertaking of Cochrane and eroding public confidence in Cochrane ́s work. My expulsion should be seen in this context.
There has also been a serious democratic deficit. The role of the Governing Board has been radically diminished under the intense guidance of the current central executive team and the Board has increasingly become a testimonial body that rubber-stamps highly finalized proposals with practically no ongoing in-put and exchange of views to formulate new policies. On dozens of issues the Board can only vote yes or no with very little opportunity to amend or modify the executive team ́s proposals.
This growing top-down authoritarian culture and an increasingly commercial business model that have been manifested within the Cochrane leadership over the past few years threaten the scientific, moral and social objectives of the organization. Many Cochrane centres have sustained negative pressure and a lack of productive dialogue with the CEO of the central office. Upon alerting the Cochrane leadership of these worrisome tendencies that negatively affect the operability and social perception of our scientific work, the Nordic Cochrane Centre has received a number of 2 threats to its existence and financing. Many of the directors or other key staff of the oldest Cochrane centres in the world have conveyed their dissatisfaction with the senior central staff’s interactions with them. While the declared aims of interactions with the central office is to improve the quality of our work, the heavy-handed approach of some of the central staff has sometimes created a negative environment for new scientific initiatives, open collaboration and academic freedom.
There has also been criticism in Cochrane concerning the over-promotion of favourable reviews and conflicts of interest and the biased nature of some scientific expert commentary used by the knowledge translation department of Cochrane.
At the same time, Cochrane has been giving less and less priority and importance to its civic and political commitment to promoting open access, open data, scientific transparency, avoiding conflicts of interest and, in general, not promoting a public interest innovation model. I feel that these issues are intricately related to providing “better evidence” as the Cochrane motto professes. Recently the Cochrane executive leadership has even refused to comment publicly on new health technology policies, open access policies and other key advocacy opportunities despite the fact that an auditing of Cochrane fulfilment of objectives has shown a total failure to comply with Cochrane advocacy objectives. There is stronger and stronger resistance to say anything that could bother pharmaceutical industry interests.
The excuse of lack of time and staff (around 50) is not credible.There has also been great resistance and stalling on the part of the central executive team to improving Cochrane ́s conflict of interest policy. A year ago, I proposed that there should be no authors of Cochrane reviews to have financial conflicts of interests with companies related to the products considered in the reviews. This proposal was supported by other members of the Board, but the proposal has not progressed at all.
The Cochrane executive leadership almost always uses the commercial terms of “brand”, “products” and “business” but almost never describes what is really a collaborative network with the values of sharing, independence and openness. To the chagrin of many senior leaders in Cochrane, the word “Collaboration”, which is part of our registered charity name, was deleted from communications about Cochrane. Nevertheless, it is precisely “collaboration” that is the key to what distinguished Cochrane from other scientific organisations where competition is at the forefront. The collaborative aspect, social commitment, our independence from commercial interests and our mutual generosity are what people in Cochrane have always appreciated the most and have been our most cherished added-value.
Often it is forgotten that we are a scientific, grass-roots organisation whose survival depends entirely on unpaid contributions from tens of thousands of volunteers and substantial governmental support throughout the world. We make a substantial contribution to people’s understanding and interpretation of scientific evidence on the benefits and harms of medical interventions, devices and procedures that impact the population.
Our work informs government legislation globally, it influences medical guidelines and drug approval agencies. Therefore, the integrity of the Cochrane Collaboration is paramount. We pride ourselves on being global providers of “trusted evidence” on a foundation of values such as openness, transparency and collaboration.
However, in recent years Cochrane has significantly shifted more to a business -a profit-driven approach. Even though it is a not-for-profit charity, our “brand” and “product” strategies are taking priority over getting out independent, ethical and socially responsible scientific results. Despite our clear policies to the contrary, my centre, and others, have been confronted with attempts at scientific censorship, rather than the promotion of pluralistic, open scientific debate about the merits of concrete Cochrane reviews of the benefits and harms of health care interventions.
Because of this moral governance crisis of the Cochrane Collaboration, I decided to run for a seat on the Governing Board and was elected in early 2017, with the most votes of all 11 candidates. It was considered an achievement, especially since I was the only one who had questioned aspects of our leadership. Regrettably today, I have been expelled because of my “behaviour”, while the hidden agenda of my expulsion is a clear strategy for a Cochrane that moves it further and further away from its original objectives and principles. This is not a personal question. It is a highly political, scientific and moral issue about the future of Cochrane. As most people know, much of my work is not very favourable to the financial interests of the pharmaceutical industry. Because of this Cochrane has faced pressure, criticism and complaints.
My expulsion is one of the results of these campaigns.
What is at stake is the ability of producing credible and trustworthy medical evidence that our society values and needs.
Peter C Gøtzsche
Professor, Director, MD, DrMedSci, MSc
Nordic Cochrane Centre
Rigshospitalet, Dept 7811